Essentia Health St. Mary's-Detroit Lakes

Current ER Wait Time

:30hours | minutesAs of 3/3/2015 1:36:00 PM

Wait times are approximate and provided for information purposes only. If you are having a medical emergency, call 911.

Essentia Health St. Mary’s-Detroit Lakes, one of Essentia Health’s many Catholic facilities, is an 87-bed acute-care facility in Detroit Lakes, Minn. It supports primary and select secondary patient services, including a 12-bed women’s unit with four birthing rooms, three operating rooms, 24-hour Certified Registered Nurse Anesthetist services, imaging services including CT, MRI and digital mammography and laboratory services. With a new clinic directly attached to the hospital, the people of Becker County and surrounding communities can receive their entire healthcare under one roof.

Rights alone do not guarantee the achievement of our objectives to provide safe, quality, compassionate care. Each patient has a responsibility to:

Follow the treatment plan prescribed. It is your responsibility to advise the people treating you whether or not you think you can, or want to, follow a certain treatment plan. You accept the consequences for outcomes if you do not follow instructions for your care;

Report changes in your health to the people treating you;

Be honest and direct with the people caring for you. You are the center of the healthcare team. Tell them exactly how you feel about the things that are happening to you;

Understand your health problems and treatment plans to your satisfaction. Understanding your health problems is important to the success of the treatment plan. If you do not understand them, ask the doctor and other caregivers. You should also recognize the impact of your lifestyle on your health.

Provide Essentia Health with a copy of your Advance Directive/ Living Will and/or Durable Power of Attorney for Healthcare.

Follow Essentia Health’s policies affecting patient care and conduct.

Provide necessary insurance information and for working with Essentia Health in making arrangements for payment of your bill if necessary.

Respect all persons and property, and for considering the privacy and rights of others when you have visitors or are using the television, radio or telephone.

When you want to know, please ask. If you have something to say, please speak up. If a concern arises, please let us know immediately.

Thank you for placing your trust in us.

PATIENT RIGHTS & RESPONSIBILITIES

We want to encourage you, as a patient at Essentia Health, to speak openly with your health care team, take part in your treatment choices, and promote your own safety by being well informed and involved in your care. Because we want you to think of yourself as a partner in your care, we want you to know your rights as well as your responsibilities during your stay at our facilities. We invite you and your family to join us as active members of your care team.

Essentia Health is committed to providing safe, quality, compassionate health care. In accordance with this commitment, we believe that patients are entitled to the following rights and have been given a copy:

Care decisions / informed consentPatients have the right to be informed about and to participate in decision making related to their care.

Patients have the right to obtain from their physician complete, current information concerning diagnosis, treatment and prognosis in terms patients can be reasonably expected to understand. When it is not medically advisable to give such information to patients, the information should be made available to an appropriate person on their behalf. Families are encouraged to participate in decisions regarding care when such participation is appropriate.

Patients have the right to receive from their physician information necessary to give informed consent prior to the start of any procedure and/or treatment. Where medically significant alternatives for care or treatment exist, or when patients request information concerning medical alternatives, patients have the right to such information. Patients also have the right to know the name of the person responsible for the procedures and/or treatment.

Except in emergencies, patients may not be transferred to another facility without being given a full explanation for the transfer, without provision being made for continuing care, and without acceptance by the receiving institution.

Patients have the right to considerate and respectful care, including privacy, security, safety and freedom from all forms of abuse, neglect, exploitation and harassment

All patients have the right to consideration of privacy during their medical care. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly. Paper and electronic medical records and other patient documents will be used in a manner which will preserve the identity of the individual patient from display to persons not authorized to have such information.

Patients have the right to know the identity and professional status of all staff members and physicians providing services. Patients have the right to be treated in an environment that provides for their security and safety.

Advance directives / ethical issues

Advance Directives for medical care such as Health Care Directives, Living Wills or the designation of a surrogate decision maker or agent are respected to the extent provided by law. These documents state your wishes about treatment or name someone to decide for you if you are unable to do so. Patients may receive information about advance directives if they make such a request.

Ethical questions that may arise concerning various treatment options may be first explored with the physician involved with the case and, if necessary, may be taken to the Bioethics Committee. This may be done by staff, providers, patients or their families by speaking to the appropriate manager.

If you have a complaint or grievance regarding an Advance Directive, follow the Grievance Procedure included in this booklet.

Refusal of treatment

Patients have the right to refuse treatment to the extent permitted by law and to be informed of the medical consequences of this action. Patients have the right to refuse to participate in research investigation or clinical trials without limitation.

Cultural and religious practices

Essentia Health respects and accommodates the cultural and religious practices or ceremonies of patients and their families unless such practices would be in direct conflict with the ethics or values of Essentia Health.

Confidential records and information

Patients have the right to expect that all communication and records pertaining to their care be treated confidentially and that requests for access to their records will be met within a reasonable period of time. You may review your medical records, request amendment to, and obtain information on disclosure of your health information, in accordance with law and regulation.

Pain management

Pain can be a common part of the patient experience. Patients have the right to appropriate assessment and management of pain. Patients’ right to pain management is respected and supported.

Special communication needs: hearing, sight and language

Patients have the right to communication that they can understand. If patients are hearing impaired, Essentia Health will provide, at no cost, a qualified language interpreter and/or auxiliary aids to offer patients effective access to our health care services. Patients should inform staff when the appointment is made if they wish an interpreter, auxiliary aid or telecommunications device for the deaf (TDD).

If patients are sight impaired, appropriate services, information and auxiliary aids will be provided. Patients should notify the registration staff when the appointment is made.

If patients of family members speak a language other than English, Essentia Health is willing to make every attempt to locate an interpreter. Patients may request an interpreter through registration or clinical staff.

Billing process

Patients have a right to receive a statement of their account if a payment is due from them. Patients with questions about their bill are encouraged to call Business Services – Patient Accounts.

Health coverage

The Affordable Care Act, signed into law March 2010, puts American consumers in charge of their health coverage and care by:

Stopping insurance companies from limiting the care you need – which will help children (and eventually all Americans) with pre-existing conditions gain coverage and keep it,

Removing insurance company barriers between you and your doctor – which will protect all Americans’ choice of doctors and end lifetime limits on the care you may receive.

For questions about your benefits and/or how these protections may apply to your health insurance plan contact your Plan Administrator.

To learn more about the new benefits and cost savings available to you under the Affordable Care Act, please visit www.HealthCare.gov. This website will help you make informed decisions about health care coverage by offering easy-to-understand information about what health plans are available in your state; how much they cost; what they cover, and lots more information tailored to your specific needs.

Visitors

Patients may designate persons who are permitted to visit during their stay at an Essentia Health facility including, but not limited to, a spouse, a domestic partner (including a same-sex domestic partner), another family member, or a friend. Essentia Health will not deny visitation on the basis of age, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and gender identity or expression.

Patients also have the right to withdraw or deny such consent at any time.

Relationship with other health services

Patients or their designated representative have the right to receive information upon request about Essentia Health’s relationship with outside providers to which patients may be referred.

Grievance procedure

Patients have the right to voice their concerns about the care they receive. If you have a problem or complaint, talk to your physician, nurse, or department leader. You may also contact the Patient Relations Department or Patient Advocate.

Please express your concerns about patient care, safety, services, or medical treatment personally, by telephone or in writing to the facility where you received care, or:

Most people do not want to think about death and dying -- so they don't. Until they have to.

Unfortunately, that often means that families are left struggling with difficult decisions about important matters, such as whether or not Mom would like to be kept alive using a ventilator, or who should be in charge of managing Dad's financial affairs, because Mom or Dad never made clear what they wanted for themselves.

Advance directives are important tools for anyone to have, because even the healthiest person could experience a sudden accident and not be able to speak for herself. But when you have a life-threatening illness, it's particularly critical to make clear, in writing, what your wishes are should the time come when you can't express them yourself.

There are two primary kinds of advance directives:

A living will spells out your preferences about certain kinds of life-sustaining treatments. For example, you can indicate whether you do or do not want interventions such as cardiac resuscitation, tube feeding, and mechanical respiration.

A power of attorney directive names someone that you trust to act as your agent if you are unable to speak for yourself. If you want to choose one person to speak for you on health care matters, and someone else to make financial decisions, you can do separate financial and health care powers of attorney.

A power of attorney may be more flexible, since it's impossible to predict all the medical decisions that might come up in the future and spell out your exact preferences for all of these situations. Many states actually combine the living will and power of attorney into one "advance directive" form.

You should only assign someone power of attorney to make your medical decisions if you have someone you trust to carry out your wishes. For example, your husband or daughter might find it painful to comply with your preference not to have a breathing tube inserted.

Thinking About a Living Will

When you do choose a medical power of attorney, you will probably want to put some specific things in writing as to the kind of care you would want should you not be able to express your wishes directly. Some things to think about:

Do you want all pain relief options available, even if they may have the side effect of unintentionally hastening your death?

Which life-sustaining options -- such as tube feeding, mechanical ventilation, CPR, and antibiotics -- do you want, and which would you not want? How long would you want these options to be continued if your condition is not improving?

Would you want artificial life support removed if you are found to be irreversibly brain dead, or do you prefer that your life be sustained until your heart stops on its own?

What are your feelings about organ donation?

How do you want your body to be disposed of after death? (Burial, cremation, medical research?) Which funeral home or other organization do you want to handle the arrangements?

Each state has its own form for advance directives, giving you questions to answer and specific things that you can choose to accept or reject, but you can always add additional information about your wishes if the form does not include everything you're concerned about.

Choosing a Medical Power of Attorney

If you decide to choose a medical power of attorney, here are some things to look for:

Someone who is not intimidated by medical professionals and is willing to ask challenging questions

Someone who can put aside their own feelings about a particular procedure or medical option in order to ensure that your wishes are carried out

You might also want to think about an alternate power of attorney if your first choice is unable to carry out the job.

Once you choose a medical power of attorney, continue talking with him or her on an ongoing basis about possible situations that might occur, and how you would want them handled. Although you cannot anticipate every possibility, the more you talk with this person about your wishes in general, the better they will understand your overall desires about care at the end of your life.

Here are some possibilities you may want to discuss:

How do you feel about being fed or hydrated through a tube?

Would you want to receive certain treatments, like antibiotics, tube feeding, or mechanical ventilation, for a trial period and have them stopped if a certain time passed with no improvement?

How aggressive do you want your doctors to be about the use of CPR should your heart stop?

What are you most afraid of regarding treatments you might receive?

What are you afraid might happen if you can't make decisions for yourself?

Are there circumstances under which you would want more aggressive measures taken to sustain your life, and others under which you wouldn't?

Making It Legal

Whether you write a living will, choose a medical power of attorney, or both, you will need to make those decisions legally binding, in writing. There are state-specific forms for advance directives like these; you do not need an attorney to prepare them.

You can download the forms you need from http://www.caringinfo.org. Their main page links directly to a menu for downloading each state's advance directive forms. Each state's form is different, so be sure to use the correct form for your state. You will generally need to have your form witnessed and/or notarized, so take careful note of the requirements for your state.

Once you have completed your advance directive, you should ensure that everyone involved in your care has a copy and is aware of it: your doctor, your hospital, your hospice or palliative care team, important family members, and your attorney if you have one.

At Essentia Health, we are committed to serving the healthcare needs of you, your family, and your community in the most caring and effective way possible. We are dedicated to our mission of making a healthy difference in people’s lives, and we are always seeking ways to improve our quality of care and customer service.

CaringBridge provides free websites that connect people experiencing a significant health challenge to family and friends, making each health journey easier. You can access the CaringBridge website from any our public computers in our lobby’s and family waiting areas.

+ HIE-Bridge Medical Records Locator

To better serve our patients, Essentia Health is participating in a new database that makes it easier for physicians and other healthcare providers to locate a patient’s medical records.

This secure database, called HIE-Bridge, does not contain a patient’s medical records, but instead lists the specific location(s) where these records can be found.

As a patient of Essentia Health system, your name and the location of your medical records have been included in this database. If you do not want to be listed in the HIE-Bridge record locator, you must complete a form to opt-out.

What is HIE-Bridge?
HIE-Bridge is a secure database that authorized medical professionals can use to locate medical records within health care organizations across northeastern Minnesota, northwestern Wisconsin and North Dakota. It stands for Health Information Exchange Bridge.

Does HIE-Bridge contain my medical records?
No. It only lists the location(s) where your medical records are stored.

How does HIE-Bridge benefit me?
It allows authorized medical professionals to find out where your medical records are kept, so they can call to have information, like lab and test results, transferred to the facility where you are currently being treated. This can result in faster and better decisions about your care, especially in an emergency.

What if I don’t want to participate?
You need to opt-out in writing. Click here for the form, which you must print out. Complete the form, sign it and then mail it to:
Essentia Health Registration Department
400 E. Third St.,
Mail Drop M3C00
Duluth, MN 55805

Once we receive your signed form, your name will be removed from the database. You can opt back in at any time.

For more information about HIE-Bridge, visit www.HIEBridge.org, or call (218) 625-5515 or 1-877-411-2442.

+ Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND
HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

To protect your privacy while we handle your health information, Essentia Health follows applicable laws, rules and procedures. We are required by law to provide you with this Notice of Privacy Practices ("Notice"). This Notice tells you about the ways in which Essentia Health may use and disclose (share) health information about you. We also describe your rights to the health information we keep about you, and describe our obligations regarding the use and disclosure of your health information.

"Health information" means any information, whether oral, electronic or paper, which is created or received by Essentia Health and is related to your health care or payment for the provision of medical services. We understand that health information about you and your health care is personal. We are committed to protecting health information about you. The information documenting the care and services you receive from Essentia Health is contained in a medical record, which is the physical property of Essentia Health. We need this record to provide you with quality care, bill for your care and comply with legal requirements. Typically, your medical record contains your demographic information (such as how we can reach you and your social security number), symptoms, examinations, test results, diagnoses, treatments, care plans and other related information.

Who will follow this Notice?

This Notice applies to all Essentia Health entities and healthcare practice sites located in Minnesota, Wisconsin, Michigan,
North Dakota and Idaho (collectively referred to as "Essentia Health"). A list of current Essentia Health locations is
available at www.essentiahealth.org.

This Notice applies to all of the records of your care that we maintain, whether made by our staff (such as physicians, nurses, therapists, and other health care providers not employed by Essentia Health), support staff, volunteers and
authorized trainees, or by your personal doctor. If your personal doctor is not an Essentia Health doctor, he or she may have different policies and notices regarding use and disclosure of your health information created in that doctor's office or clinic.

This Notice describes Essentia Health's practices and that of all:

departments, hospitals, clinics and other locations;

residents, medical students and other trainees affiliated with Essentia Health;

volunteers who may assist you; and

employees, staff and contractors.

Federal and State Laws

Health information may be protected by both federal and state laws and regulations. Essentia Health is required to follow both sets of rules. Sometimes these rules are different. In those cases, Essentia Health must follow the rules that provide greater protection of health information and grant our patients greater rights. Where a state law is more stringent, we have listed that in this Notice.

Use and Disclosure of Your Health Information

To provide you with the most comprehensive and high quality care, we will need to use and disclose your health information. When we use and disclose your health information, we follow the law and take steps to protect your information. We may use and disclose your health information as follows:

Treatment, Payment and Health Care Operations: We may use and disclose your health information for:

treatment (for the provision, coordination and management of care, includes sharing information with non-Essentia Health providers who are involved in your care);

payment (such as providing bills, service dates, symptoms and diagnosis to you and your insurance company);
and

our health care operations. Such activities are necessary for us to provide you with services and manage our organization. Examples of such activities include, but are not limited to: quality improvement activities throughout
Essentia Health, evaluating our physicians and staff, conducting training activities, obtaining legal and accounting services, conducting audits, business planning and other management activities.

We may disclose your health information to a non-Essentia Health provider or entity so that they can provide you with
treatment and for continuity of care. For example, you may need services for rehabilitation after a surgery and we will
share your information to make such arrangements. We may also disclose your information with non-Essentia Health
providers or entities for them to obtain payment for services provided.

We arrange to provide some services through contracts with business associates. On occasion, we may disclose your
health information to business associates acting on our behalf so they can perform the service that we have asked them
to do. To protect your health information, however, we require the business associate to appropriately safeguard your
information.

Additional applicable state law requirements: Minnesota law generally requires patient consent for disclosures of health information by Essentia Health Minnesota entities for treatment, payment and health care operation purposes, unless the disclosure is to an Essentia Health-related entity or consent is not possible due to a medical emergency.

Appointment Reminders and Treatment Alternatives: At times we may access your health information to set up or
remind you about future appointments, provide information about treatment and health-related benefits or services that
may be of interest to you.

Marketing: We generally must obtain your written authorization before using your health information for marketing
purposes. Without your written authorization, we can provide you with marketing materials in a face-to-face encounter
and we may provide you with a promotional gift of very small value, if we so choose. We may also communicate with you
about products or services relating to your treatment, to coordinate or manage your care, or provide you with information
about different treatments, providers or care settings.

Facility Directory/Patient Census: We may include your name, location in a facility, health condition (in general terms,
such as "good", "fair") and religious affiliation (should you choose to provide one) in current patient lists for our facilities.
This information is maintained for Essentia Health personnel to assist family members, staff and others in locating you
while you are at an Essentia Health facility. This information (with the exception of religious affiliation) may be provided to
people who ask for you by name and to Essentia Health institutionally-related foundations. This information (including
religious affiliation) may be provided to members of the clergy. If you do not wish to have Essentia Health disclose this
information, please inform the person assisting you with registration or admission.

Relatives, Close Friends and Others Involved In Your Care: Healthcare professionals, using their best judgment, may
disclose to a family member, close personal friend or any other person you identify, health information relevant to that
person's involvement in your care or payment related to your care. If family members or friends are present while care is
being provided, Essentia Health will assume your companions may hear the discussion, unless you state otherwise. If
you do not want Essentia Health to disclose your health information to your family members or others who are involved
with your care or handling your bills, please inform the person assisting you during registration or admission.

Disaster Relief: In the event of a declared disaster, we may disclose your name and location to a public or private entity
authorized by law or by its charter to assist in disaster relief efforts (e.g., the Red Cross).

Fundraising: We may contact you about supporting our fundraising efforts, programs and events to support our mission.
We may use certain information (name, date of birth, address, email address, telephone number, dates of service, age,
gender, department of service, treating physician, outcome information and health insurance status) to contact you in the
future to raise money for Essentia Health. We may also disclose this information to our institutionally-related foundations
for the same purposes. We do not sell or rent patient names or contact information to organizations outside the Essentia
Health family without your authorization. If, upon receiving a fundraising communication, you wish to opt-out from
receiving further fundraising communications, please refer to the op-out instructions provided on the letter or form sent to
you.

Medical Research: Conducting medical research is an important part of Essentia Health's mission. Federal regulations
permit use of health information in medical research, either with your authorization or when the research study at Essentia
Health is reviewed and approved by an Institutional Review Board before any medical research study begins. In some
situations, limited information may be used before approval of the research study to allow a researcher to determine
whether enough patients exist to make a study scientifically valid.

Additional applicable state law requirements: Minnesota law generally requires patient consent for disclosure of protected
health information by Essentia Health Minnesota entities to outside researchers for medical research purposes. Essentia
Health Minnesota entities will obtain such consent from their patients or refusal to participate in any research study, or will
make a good faith effort to obtain such consent or refusal, before releasing any identifiable information to an outside
researcher for research purposes.

Record Locator Services (may also be known as a HIE- Health Information Exchange): In the event of a medical
emergency, we may share your demographic information (name, address, date of birth, gender and location of your health
record) with a medical record locator service. This information will help caregivers identify where you have a health
record(s) and will assist caregivers to make better decisions about your treatment. For example, if you are admitted to a
hospital on an emergency basis and cannot provide important information about your health condition, this service will
allow us to make your health information from other participants available to those who need it to treat you at the hospital.
When it is needed, ready access to your health information means better care for you.

If you do not want to be included in the record locator service, you may opt-out by completing a written opt-out form. Your
opt-out decisions will remain in effect until you notify us in writing that you wish to change these instructions. You can ask
for this form at any Essentia Health registration location, your local Essentia Health medical records department or contact
the Essentia Health Privacy Officer at compliance@essentiahealth.org or call (218) 786-8376 and ask for the Essentia
Health Privacy Officer.

To Avert a Serious Threat of Harm: Under certain circumstances, and as permitted by applicable law, we may use and
disclose health information about you, when necessary, to prevent a serious and imminent threat to the health and safety
of you, another person or the general public.

Organ and Tissue Donation: In the event our clinical professionals determine that a patient may be a candidate for
organ/tissue donation and consistent with applicable law, we may disclose your health information to organizations or other entities involved in the procurement, banking or transplantation of organs/tissue or to other health care providers as
needed to make transplantation possible.

Military Authorities/National Security: We may release protected health information to authorized federal officials for
military, intelligence, counterintelligence or other national security activities authorized by law. Essentia Health may also
disclose protected health information to authorized federal officials so they may provide protection to the President or
other authorized individuals.

Additional applicable state law requirements: Minnesota law generally requires patient consent for disclosures of
protected health information by Essentia Health Minnesota entities for military and national security purposes, unless the
disclosure is specifically required by federal law.

Workers' Compensation: If you are seeking workers' compensation for a work-related illness or injury, we may release
health information related to your claim, as permitted or authorized by the state Workers' Compensation program.

Public Health Activities: We may disclose health information about you for legally authorized or required public health
activities, such as in cases of "mandatory reporting". These may include such things as preventing or controlling disease;
injury or disability; reporting births and deaths; reporting reactions to medications or problems with products; notifying
people of recalls of products they may be using; and notifying a person who may have been exposed to a disease or may
be at risk for contracting or spreading a disease or condition.

Additional applicable state law requirements: Wisconsin law allows a physician or optometrist to report a patient's name
and other information relevant to the patient's condition to the Wisconsin Department of Transportation without the
patient's permission, if he/she deems that the patient's condition affects the patient's ability to operate a motor vehicle.

Health Oversight Activities: We may disclose health information to a health oversight agency for legally authorized
activities, such as audits, investigations, inspections and licensure. Through these activities the government monitors the
health care system, government programs, and compliance with applicable laws and regulations, including civil rights
laws.
Law Enforcement Activities: We may disclose your health information to the police or other law enforcement officials as
required or permitted by law, including in response to a court order, subpoena, summons, warrant, or similar process. If
we reasonably believe you are a victim of abuse, neglect or domestic violence and the reporting of such information is
required or allowed by law, we may disclose your health information to a governmental authority, including a social service
or protective services agency. Should you be an inmate of a correctional institution, we may disclose to the institution or
agents thereof health information necessary for your health and the health and safety of other individuals in accordance
with state and federal requirements.

Additional applicable state law requirements: Minnesota law generally requires patient consent for disclosures of
protected health information by Essentia Health Minnesota entities for law enforcement purposes, unless the disclosure is
in response to a valid court order or warrant.

Judicial and Administrative Proceedings: We may disclose your health information in the course of any judicial or
administrative proceeding as required or permitted by law, including in response to a court/administrative order, subpoena
or similar process.

Coroner, Medical Examiners and Funeral Directors: We may disclose health information to a coroner or medical
examiner when necessary to identify the deceased, determine the cause of death or as otherwise authorized by law.
Essentia Health also may release protected health information to a funeral director as necessary to carry out the funeral
director's duties, including arrangements in reasonable anticipation of and after death.

Additional applicable state law requirements: Minnesota law generally requires the consent of a patient's authorized
family or legal representative for disclosures of health information by Essentia Health Minnesota entities to funeral
directors.

Required By Other Laws: We will use or disclose health information when required by other federal, state or local laws.

Alcohol & Drug Abuse Records: If you are a recipient of alcohol or drug abuse treatment, provided by a federally
assisted alcohol and drug abuse program, your health information is protected by special federal confidentiality laws (42 CFR Part 2). Your health information will be disclosed to Essentia Health staff and representatives within the alcohol or drug abuse treatment program and certain organizations providing services to the program that have a need to know your health information to perform their job duties or to medical personnel in the event of a medical emergency. Your authorization will be obtained prior to disclosing any health information to obtain payment for services rendered to you, such as for example, to your insurance company. On occasion, your health information may be used for health care operations. Essentia Health will not respond to inquiries about your treatment and will not disclose information revealing that you are a patient of the alcohol or drug abuse treatment program to unauthorized individuals who call Essentia Health to seek information. Your health information will not be disclosed to a family member, relative or any other person seeking information about your care unless your written authorization is obtained. If you are a minor or have a personal representative (such as a guardian or person authorized under a power of attorney), you will be consulted prior to sharing information with such person. If you refuse to grant permission or are unable to grant permission, information may be shared with your personal representative only to the extent permitted or required by state law. Essentia Health will comply with federal and state law in reporting your health information for public health activities or health oversight activities. If you disclose information related to child abuse, Essentia Health may be required to report such information to governmental authorities responsible to investigate such abuse. If you commit a crime on the premises, your health information may be used to report the crime. To the extent possible, Essentia Health will notify you or seek a protective order prior to disclosing information to a judicial or administrative proceeding.

A violation of these laws is a crime and may be reported to the appropriate authorities.

Information with Additional Protections: Certain types of health information may have additional protection under federal or state law. For example, HIV/AIDS and genetic testing results have additional protections under certain state laws. Psychotherapy notes may carry additional protections as well. To the extent applicable, Essentia Health would need to obtain your written authorization before disclosing that information to others in many circumstances.

Uses & Disclosures With Your Authorization: We may only use or disclose your health information with your written permission except as described in this Notice or specifically required or permitted by law. For example, uses and disclosures made for the purpose of psychotherapy, marketing and the sale of protected health information require your authorization. If you give written permission, you have the right to withdraw your permission for future uses and
disclosures by notifying Essentia Health in writing. A form to revoke your permission is available from the local medical records department or through contacting Essentia Health's Privacy Officer at compliance@essentiahealth.org or (218) 786-8376. Your permission will end upon receipt of and approval of the signed form.
Notification of a Breach of Your Information: Essentia Health is required by law to maintain the privacy of your
information and notify you following a breach of your unsecured protected health information.

Right to Inspect and Copy: You have the right to request in writing that you see and obtain a copy of the health
information that we use to make decisions about your care. You have the right to request that the copy be provided in an
electronic form or format (e.g., PDF saved onto a CD). If the form and format are not readily producible, we will work with
you to provide it in a reasonable electronic form or format. We may charge a fee for the costs of copying, mailing or other
supplies and services associated with your request. If we deny your request to inspect or obtain a copy in certain limited
circumstances (for example, we may deny access if your physician believes it will be harmful to your health or could
cause a threat to others), you may be able to request that the denial be reviewed (the grounds for denial must be
reviewable by law). If such a review is agreed upon, another licensed health care professional chosen by Essentia Health
may review your request, and we will comply with the outcome of that review.

To make such a request, please contact your local Essentia Health medical records department.

Additional applicable state law requirements: Minnesota law requires a written and legally compliant patient consent for
disclosures of health information to the patient themselves. Therefore, the proper Essentia Health form must be
completed and received prior to such access being granted.

Right to Request Alternate Methods of Communication: You have the right to request, in writing, but without needing
to state a reason, that confidential communications about you be made in an alternative manner (such as by phone or
secure messaging) or at a certain location. We will accommodate reasonable requests. Your request must specify how
or where you wish to be contacted in the future.

To make such a request, please contact your local Essentia Health medical records department or contact the Essentia
Health Privacy Officer at compliance@essentiahealth.org or (218) 786-8376.

Right to Request Amendment: If you believe that health information we have about you is incorrect or incomplete, you
may make a written request to ask us to amend information. The request should state the reason for the amendment and
specify the information to be amended. Any amendment we make to your health information will be disclosed to those
with whom we previously disclosed the amended information.

We may deny your request for an amendment if the request is not in writing or does not state a reason. We may also
deny your request if the information to be amended was not created by Essentia Health (unless the creator of the
information is no longer available to amend it), is no longer maintained by Essentia Health, is not part of the information
which you would be permitted to see and copy, or is accurate and complete. We will notify you in a timely manner of our
response to your request for amendment. If we deny your request, you may submit a statement disagreeing with our
denial, or you may direct that your request for amendment and our denial be included with any future disclosures of the
information you requested to amend. If you submit a statement of disagreement, we may prepare and provide you with a
copy of a written statement of rebuttal, and your statement of disagreement and our rebuttal will be included in
subsequent disclosures of the information.

To make such a request, please contact your local Essentia Health medical records department or contact the Essentia
Health Privacy Officer at compliance@essentiahealth.org or (218) 786-8376.

Right to a List of Certain Disclosures: You have the right to make a written request for a list of disclosures we have
made of your health information, except for uses and disclosures for treatment, payment, and healthcare operations, as
previously described, and those for which you have authorized disclosure. Your request must state a time period, which
may not be longer than six years. The first list requested within a 12-month period shall be provided at no charge. For
additional lists requested during the same 12-month period, Essentia Health may charge for the costs of providing the list.

To make such a request, please contact your local Essentia Health medical records department or contact the Essentia
Health Privacy Officer at compliance@essentiahealth.org or (218) 786-8376.

Right to Request Restrictions: You have the right to request a restriction or limitation on the medical information we
use and disclose about you for treatment, payment or health care operations, or to assist others' involvement in your care.
Your request must be in writing, state the restrictions that you are requesting, and state to whom the restrictions apply.
Please note, because of the integrated nature of Essentia Health's medical record, Essentia Health is not generally able
to honor most requests, nor, in most cases, is Essentia Health legally required to do so. Essentia Health must accept
your request for restriction in the case of a disclosure restricted to a health plan if the disclosure is for the purpose of
carrying out payment or health care operations, and is not otherwise required by law; and the protected health information
pertains solely to a health care item or services for which you, or the person other than the health plan on your behalf, has
paid Essentia Health in full. If we do agree to your restriction request, we will comply with your request unless the
restricted information is needed to provide you with emergency treatment or we notify you that we are terminating our
agreement to a restriction.

To make such a request, please contact your local Essentia Health medical records department or contact the Essentia
Health Privacy Officer at compliance@essentiahealth.org or (218) 786-8376.

Key Information about this Notice

This Notice takes effect September 23, 2013. It will remain in effect until we replace it. We may change this Notice and
make the new changes applicable for all health information we created or received before and after we made changes to
our Notice. We will make any revised Notice available in hard copy and display it in our locations and on our website.
Also, you can request the revised Notice in person or by mail.

If you have any questions, or would like to discuss this Notice in more detail, please contact the Essentia Health Privacy
Officer at compliance@essentiahealth.org or (218) 786-8376.

Complaints

If you are concerned that your privacy rights may have been violated or you disagree with a decision we make about your
health information, please contact the Essentia Health Privacy Officer at compliance@essentiahealth.org or (218) 786-
8376.

You may also send a written complaint to the United States Department of Health & Human Services- Office of Civil
Rights. Our Privacy Officer can provide you with information on how to file such a complaint.

Under no circumstances will we ever ask you to waive your rights under this Notice or retaliate against you in any manner
for filing a complaint. Essentia Health reserves the right, however, to take necessary and appropriate action to maintain an
environment that serves the best interests of its patients and providers.

Throughout Essentia Health we are called to make a healthy difference in people’s lives.

As a member of the Essentia Health family, St. Mary's-Detroit Lakes's mission as a Catholic, Benedictine sponsored facility is to promote Christ’s ministry of holistic healing for all human life with special concern for the poor and powerless.

+ Leadership

Peter Jacobson, President
In addition to serving as president of Essentia Health St. Mary's-Detroit Lakes, Peter Jacobson is senior vice president of Essentia Health's West Region-Minnesota Market. He joined Essentia Health in 2008 initially as vice president and then as senior VP of Clinic and Regional Operations for Essentia Health-West Region. He has over 20 years of senior healthcare leadership experience gained through his past positions with critical access hospitals, community hospitals and multi-state integrated health systems, and now Essentia Health.

Richard Vetter, MD, Clinical Services Chief, Essentia Health West Region
Dr. Vetter graduated from the University of North Dakota Medical School, and has been a member of the Essentia Health Department of Family Practice since 2008. Prior to that he was a member of the Dakota Clinic Department of Family Practice for 14 years.

Ryan Hill, Chief Financial Officer
Ryan Hill is a graduate of Concordia College in Moorhead with degrees in mathematics and healthcare finance. He is also a licensed nursing-home administrator and has been with Essentia Health St. Mary's-Detroit Lakes since 2008. Previously he served as chief financial officer for Essentia Health-Ada.

Shawn Christianson, Chief Quality Officer
Shawn Christianson has been with Essentia health St. Mary's since 2010. She received her MBA from St. Thomas University, Minneapolis, and after managing a mental health practice for 10 years in the cities, returned "home" to Fargo, ND.

Kay Larson, Chief Nursing OfficerKay Larson has been with the organization for 18 years and has over 36 years of nursing experience in the in-patient, home care and ambulatory settings. Her current responsibilities include oversight of all nursing functions and Emergency Medical Services in Detroit Lakes. She graduated with a bachelor of arts degree in nursing from Jamestown College.

Christy Brinkman, Senior Administrative LeaderChristy Brinkman has been employed at Essentia Health St. Mary's since 1999. She is a graduate of Concordia College in Moorhead, MN with degrees in business-health care administration and long-term care administration. She is a licensed nursing home administrator in Minnesota. She received a Master's in Business Administration from the University of Mary, Bismarck, ND.

LeAnn R. Mouw, Director of DevelopmentLeAnn Mouw has been with Essentia Health St. Mary's-Detroit Lakes since 1998. She is a graduate of Minnesota State University Moorhead and received her master's degree from the University of Mary.

+ Board of Directors

LaVerne Moltzan, Chair

Jim Anderson

Sr. Pauline Micke

Sr. Mary Christa Kroening, OSB

Rhoda Hooper

Cyndi Anderson

LaVerne Moltzan

Curt Noyes

Nathan Fetting

+ Certifications/Accreditations

This facility has been accredited by The Joint Commission. The Joint Commission’s “Gold Seal of Approval™” is an internationally recognized symbol of quality. This accreditation indicates that Essentia Health-St. Mary's Detroit Lakes has proven its commitment to high quality patient care and its willingness to be measured against the highest and most rigorous standards of performance.